IVF Help - Stick with conventional or switch?

[Ruby2024]

Hi everyone

I was wondering if I can get some advice on what we can do next with IVF. A bit of background...

TTC for 2 years now, now 35 as is partner. During this time, I was diagnosed with endometriosis (no symptoms apart from day 1 of period is heavy. No pain etc so this was a complete shock). I had a large endometrioma on left ovary which I was advised to have removed (especially for IVF). This was removed in May 2023. We qualified for one NHS funded round where we live so we started that in February 2024. Partner has normal SA results so did not have ICSI. During scans, another small endometrioma (around 18mm) was seen on my right ovary. For the IVF meds, I had 300 units of stimulation (Menopur).I responded well to the meds and 8 follicles were seen as growing, with another 2-3 smaller ones which they said might recruit nearer egg collection (it seems my left ovary which had the large endometrioma did take a hit during the op and some follicles were lost). 8 eggs were retrieved, only 4 were mature and of those only 2 fertilised normally... 1 did nor fertilise at all and the other fertilised abnormally. Unfortunately, the 2 which did fertilise both stopped developing at the 5 and 8 cell stage (around day 2-3). We were completely devastated, and the clinic believe it is my egg quality which is the issue. He even mentioned donor eggs as something to consider if it happens again. I was really shocked this was being mentioned so soon into the process. I will look into this if it is required but I feel at this point it's a bit early?

At the follow on consultation, we were told if we were to stay with that clinic (Care Fertility) for another round, they would switch us to a short protocol next time (I had been on long).

However, I'm really torn with what to do next..

• Should we try another round of conventional IVF and just hope for the best (I was supporting egg quality leading up to my first round, but I'm now really putting in the effort with a better diet, no gluten or dairy, limiting sugar etc). Consultant said egg quality can vary month to month so we might have just been unlucky that month. My partner thinks we should just try conventional again. Perhaps switch to a short protocol.
• Should we consider switching to mild/natural modified IVF instead? As this is meant to be focussed on egg quality, and maybe that is best for us since it is my eggs which are the issue. I have seen Create do a 3 round package.
• Is it worth getting a DNA fragmentation test done before we go again? My partner has suspected SIBO and has been on Fluxeotine (Prozac) for over 2 years and I just have a niggling feeling his sperm quality/DNA is impacted? As we had such disastrous results on the first round, is it really only my eggs causing the issue (consultant thinks not to bother with this btw). Partner is coming off this slowly and getting the right treatment for SIBO finally. He is also cleaning up his diet and adding in some supplements.
• Should we go abroad and just forget about IVF in the UK?!
• Has anyone else had a first round like this and went on to have better results?

any help and advice is really appreciated and thank you for reading to the end! I am just completely torn with what to do for the best and can't believe the result we had in this first round :( I just hope that it was a bit of a fluke and we have better luck in the future.
We are getting married in a few months so I think we need to wait for after this to do any further IVF, although I am concerned the second endometrioma will grow bigger and will need looking at before we can proceed further... argh it's honestly so overwhelming and I'm starting to feel like it will never happen for us.

Thanks again

[2mumlife]

@Ruby2024 Hi. Lots of your circumstances I don't have experience with, and I'm sure others will be along who have more experience / knowledge of some aspects of your puzzle.

So our situation - same sex couple, needed donor sperm. No known fertility issues. We did 4 medicated IUIs all BFN. We then did a long protocol IVF. I responded really poorly to the stims (menapur, also possibly gonal-f but can't quite remember if we used that on this cycle or not)so going into egg collection we weren't expecting that many but at egg collection we only got 4 eggs (less than expected - consultant called it 'empty follicle' syndrome though in his opinion the follicles aren't empty, but the eggs are stuck to the follicle wall because they are immature). Only 2 eggs were mature. We were lucky in that both fertilised and made good day 5 blasts. Our fresh transfer was a BFN and our FET was a chemical pregnancy.

2nd round we changed EVERYTHING. So did a short protocol freeze-all cycle (because ironically retesting my AMH suggested it was high so at risk of OHSS....) with ovaleap as the main stim, they let my follicles grow bigger, and they left more time between the trigger shot and egg collection. I also focussed on eating a lot of protein and did acupuncture and mindfulness. I still didn't respond great, but we got 6 eggs, all mature, all made it to day 5, but only 3 were suitable to freeze (the other 3 were left growing until day 6, but still didn't look good enough to freeze). First FET is my DD. 2nd FET is my current pregnancy (15 weeks), and that 3rd embryo is still in the freezer.

So I would say its early days given your age to move to DE. It sounds like maybe doing some investigations, changing protocol and working on both egg and sperm quality could help. You don't need loads of embryos to make your family, so even a few good embryos could be enough.

Hope this gives you some hope

[Sunflower360]

@Ruby2024, no pregnancy news to share but I'm going through FETs at the moment from my ECs. I'm 38 with low AMH around 4 pmol likely lower now and this is my journey so far...

EC 1: NHS clinic... max stims short protocol; 4 eggs, 2 mature, zero fertilisation. Decided max stims was not for me. Dr at this point also floated donor eggs if all else fails. Felt a very generic approach. They did not do mild ivf

Had a consultation with Care Fertility, was not impressed, felt like a conveyor belt approach despite it being privately funded...plus they were going to put me on long protocol. I didn't like the idea of that with my low AMH

Had a consultation with Create; much more aligned to my thought process of a more gentle approach and they also advised ICSI due to poor fertilisation. OHs sample was ok bar from slightly lower morphology so perhaps my eggs were over cooked with the high stims last time? Don't know

Changed up diet before the ECs; low carb, high protein, high dose of Coq10 for egg quality, vitamin D, and other standard supplements

EC 2 with Create Natural Modfied: 5 eggs, 4 mature; 1 x day 3 embryo (will culture soon) and 1 x blastocyst frozen

EC 3 with Create Natural Modified: 2 eggs, 2 mature, 1 x blastocyst frozen

EC 4 with Create Mild: 7 eggs, 7 mature, 7 fertilised, 5 x blastocysts frozen

Total: 14 eggs = 7 blastocysts and 1 day 3 embryo frozen.

I have gone through 2 single FETs so far unfortunately both BFN's but I'm hoping to go into another one again shortly. BFNs could be due to abnormal embryos due to my age as they were not tested, but I had some tests done with Create and have Thyroid Antibodies so could just as well be that that is causing issues....but then again I had a natural chemical pregnancy before starting with Create so jury is out on that.

Anyway, long winded response but don't let the Dr put you off from trying with your own eggs so prematurely, you're only 35 - there is a reason why HFEA recommends 3 cycles. May be worth trying another clinic to find one that is aligned to your thought process

[Ruby2024]

Thanks both @2mumlife and @Sunflower360 for replying and sharing your experiences. Best of luck to you both on your journeys.
Definitely given me food for thought and another perspective of the different IVF protocols.

[KBACU]

Hi Ruby 2024,

I wonder if you've considered acupuncture to support you through your IVF journey? It sounds like you're really well informed on the IVF treatment side of things and could be interested in finding ways to improve your egg quality and chances of success with IVF. It's also a great way to improve sperm quality. Acupuncture has been shown to have a significant effect on both pregnancy rates and live birth rates. It's also a really gentle way to support yourselves mentally during the roller coaster ride of fertility treatment.

I'm an acupuncturist in Brighton and I usually recommend couples have treatment every couple of weeks for 3 menstrual cycles (and 3 months for sperm quality) to prepare for IVF. Not always easy when you just want to get started I know!

The British Acupuncture Council has some useful fact sheets about acupuncture and IVF at https://acupuncture.org.uk/fact-sheets/infertility-art/ if you want to know more.

They also help you find a reputable practitioner local to your area.

Good luck in the meantime 😊

[Ruby2024]

Hey @KBACU thanks for replying. I did do acupuncture from November 2023 right up until my first egg collection at the beginning of March but still had crappy luck :( but I I did enjoy it and will look into it again for next time. I think my lack of success was perhaps down to something deeper with sperm/egg quality that perhaps the acupuncture couldn't help with maybe. Or even the stims themselves not being quite right for me.

But in any case, I think hopefully once I've done some further digging into the issue I'll be resuming it at some point before my next treatment. If anything it was some nice me time amongst all the craziness of infertility and IVF!

[KBACU]

Ah I'm glad to hear you found it helpful. Yes even when you don't get the ultimate outcome it provides so much support. Wishing you all the luck on your journey 😊